Improving coding and primary care management for patients with chronic kidney disease: An observational controlled study in East London

Journal article


Hull, S.A., Rajabzadeh, V., Thomas, N., Hoong, S., Dreyer, G., Rainey, H. and Ashman, N. (2019). Improving coding and primary care management for patients with chronic kidney disease: An observational controlled study in East London. British Journal of General Practice. 69 (684), pp. e454-e461. https://doi.org/10.3399/bjgp19x704105
AuthorsHull, S.A., Rajabzadeh, V., Thomas, N., Hoong, S., Dreyer, G., Rainey, H. and Ashman, N.
Abstract

Background The UK national chronic kidney disease (CKD) audit in primary care shows diagnostic coding in the electronic health record for CKD averages 70%, with wide practice variation. Coding is associated with improvements to risk factor management; CKD cases coded in primary care have lower rates of unplanned hospital admission.

Aim To increase diagnostic coding of CKD (stages 3–5) and primary care management, including blood pressure to target and prescription of statins to reduce cardiovascular disease risk.

Design and setting Controlled, cross-sectional study in four East London clinical commissioning groups (CCGs).

Method Interventions to improve coding formed part of a larger system change to the delivery of renal services in both primary and secondary care in East London. Quarterly anonymised data on CKD coding, blood pressure values, and statin prescriptions were extracted from practice computer systems for 1-year pre- and post-initiation of the intervention.

Results Three intervention CCGs showed significant coding improvement over a 1 year period following the intervention (regression for post-intervention trend P<0.001). The CCG with highest coding rates increased from 76–90% of CKD cases coded; the lowest coding CCG increased from 52–81%. The comparison CCG showed no change in coding rates. Combined data from all practices in the intervention CCGs showed a significant increase in the proportion of cases with blood pressure achieving target levels (difference in proportion P<0.001) over the 2-year study period. Differences in statin prescribing were not significant.

Conclusion Clinically important improvements to coding and management of CKD in primary care can be achieved by quality improvement interventions that use shared data to track and monitor change supported by practice-based facilitation. Alignment of clinical and CCG priorities and the provision of clinical targets, financial incentives, and educational resource were additional important elements of the intervention.

Year2019
JournalBritish Journal of General Practice
Journal citation69 (684), pp. e454-e461
PublisherRoyal College of General Practitioners
ISSN1478-5242
Digital Object Identifier (DOI)https://doi.org/10.3399/bjgp19x704105
Web address (URL)http://www.scopus.com/inward/record.url?eid=2-s2.0-85069237674&partnerID=MN8TOARS
Publication dates
Online27 Jun 2019
Publication process dates
Accepted21 Dec 2018
Deposited28 Jul 2022
Accepted author manuscript
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Open
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